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At least 451 records · Page 25Linked to original sources
PubMed1998

Salvage of failed amputation about the hip in peripheral vascular disease by open wound care and nutritional support.

Five consecutive patients with wound and/or plastic surgical flap failure after hip disarticulation or amputation at the lesser trochanteric transfemoral level were treated with local tissue debridement, open wound management, culture-specific antibiotic therapy, and nutritional supplementation. All of the patients underwent amputation about the hip as a result of ischemic necrosis of the lower extremity. Four of the five patients were able to achieve wound healing by second intention. The fifth patient died 2 months after the surgery. None of the patients required revision surgery. One patient underwent split-thickness skin grafting to minimize the need for continued wound care. Local wound management combined with nutritional support and culture-specific antibiotic therapy is an acceptable alternative to major amputation stump revision in patients with potentially high morbidity who fail to heal after amputation about the hip.

Adult↗
PubMed1998

Zosteriform cutaneous metastases from squamous cell carcinoma of the stump of an amputated arm.

The clinical appearance of skin metastases varies over a wide morphologic spectrum, cutaneous metastases mimicking herpes zoster being rare. We now report the case of an 83-year-old male with zosteriform cutaneous metastases secondary to a squamous cell carcinoma (SCC) which developed in the stump of an amputated arm. The pathogenesis is speculative, but in this case, the zosteriform distribution might well be explained by perineural lymphatic invasion and spread.

Aged↗
PubMed2000

[Hand injuries caused by self-made bombs. Observations and reconstructoin techniques. Report of 7 cases].

The authors report on their experience of sodium chlorate bomb injuries of the hand observed in seven boys. The thumb was damaged in all cases. This digit was amputated in five cases, was totally saved in one case and partially saved in another case. In four cases, the preservation of damaged tissues in the emergency procedure allowed a secondary reconstruction of the thumb, thus making it possible to achieve a prehensile and sensitive hand. In these former four cases, a posterior interosseous flap was performed to ensure the primary or secondary skin coverage. In two cases, the major lesions necessitated an amputation at the radiocarpal level. In one of these two cases, coverage of the amputated stump by a free gracilis muscle flap made it possible to minimize the level of amputation and to wear a functional prosthesis. Sodium chlorate bombs are made with an unstable chemical mixture. These reactives provoke high-energy injuries with a short range of dispersion. The damages depend on the prehensile mode, which explains why the thumb and the index finger are always injured. These blast injuries were limited to the hand and the skin coverage could be done with a distally based posterior interosseous flap. In spite of the impressive lesions observed in such young patients, a conservative attitude could be taken in an emergency situation with the aim to perform further reconstructive procedures.

Adolescent↗
PubMed1990

[Ray amputation of the hand].

The aim of a ray amputation is to improve the cosmetic appearance and function of the hand after finger amputation. Pain, reasons of appearance and impaired function of amputation stumps are good indications. The patient's occupation, hobbies, handedness and emotional attitude regarding the amputation should be assessed when ray amputation is considered.

Adolescent↗
PubMed1979

Thumb reconstruction in children through metacarpal lengthening.

In 7 children, aged 10 to 14 years, we did thumb reconstructions by a gradual lengthening of the first metacarpal. In all cases, spontaneous bone consolidation occurred between the distracted fragments. The average period of treatment was 4 months, and a mean metacarpal elongation of 88% was achieved. The quality of the skin sensitivity in the amputation stump was preserved after the lengthening.

Adolescent↗
PubMed1994

Evaluation of prognostic factors for dogs with synovial sarcoma: 36 cases (1986-1991).

Medical records of 36 dogs with synovial sarcoma confirmed by microscopic examination of H&E-stained sections of tissue were selected for retrospective analysis from dogs admitted between 1986 and 1991 to participating institutions of the Veterinary Cooperative Oncology Group. Metastasis was evident at the time of diagnosis in 8 (22%) dogs, and 15 (41%) dogs ultimately developed metastatic tumors. Median survival time for all dogs, as determined by life-table analysis, was 17 months. For dogs that were subsequently treated and became tumor free, the median disease-free interval was 30 months. Nine dogs had previously had localized excision attempted, but all had recurrence of the tumor locally (median, 4.5 months). Of 29 dogs that underwent amputation, including the 9 with localized recurrence, 2 had tumor recurrence on the amputation stump. Most dogs had survival time and disease-free interval of > 36 months after amputation. Four dogs that had received chemotherapy for tumors of advanced clinical stages did not respond to treatment. One dog that had received locally applied radiotherapy after localized excision did not have evidence of tumor recurrence 2 years after radiotherapy. Clinical stage, histologic grade, and a positive result for tests that used cytokeratin immunohistochemical staining significantly (P < 0.05) influenced survival time and disease-free interval. Analysis of data for the study reported here suggested that histologic criteria can be an excellent predictor of dogs that are likely to have tumor recurrence after amputation and that would most likely benefit from aggressive treatment with adjuvants.

Amputation, Surgical↗
PubMed1991

Aortobifemoral bypass for the critically ischaemic limb--is it worth while?

Little is written of the place of aortobifemoral bypass as a limb or below-knee-level amputation stump salvage procedure in patients presenting with critical ischaemia with threat of limb loss. Over a 4-year period 151 patients referred to the Vascular Service of the University of Natal Hospitals with aorto-iliac occlusive disease and a threatened limb were studied. All were submitted to aortobifemoral bypass. Patients were divided into two subgroups: group 1 patients presented with rest pain or focal necrosis and were submitted to aortobifemoral bypass with concomitant digital or transmetatarsal amputation; and group 2 patients were submitted to a guillotine-type below-knee amputation in view of ascending infection or extended necrosis that made below-knee amputation impracticable. The objective was to obtain healing of the stump at the below-knee level. Early results within 1 month of operation were as follows: 5 patients (3.3%) died of myocardial infarction. There was no graft sepsis, and groin wound sepsis occurred in 7 (4.5%). Of the group 1 patients 8 required major amputation (8.2%). Three patients in group 2 required proximal above-knee revision (14.3%). The overall limb or stump salvage rate within 1 month of surgery was 89.4%. It was possible to follow up 105 patients in group 1 and 18 in group 2 for between 2 years and 5 years. In group 1, 2.9% required major proximal amputation and 3.8% a subsequent femoral-to-distal bypass. In group 2 none required subsequent major proximal amputation. Overall in those available for long-term follow-up 97% retained the use of a salvaged limb or stump.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1976

Postoperative deep vein thrombosis in the lower extremity amputee: A prospective study with Doppler ultrasound.

The incidence of postoperative venous thrombosis and pulmonary embolism was assessed in 87 patients undergoing 96 major lower extremity amputations for ischemia. Prospective surveillance for deep leg vein thrombosis was carried out by Doppler ultrasound in 35 patients. There was no instance of major leg vein thrombosis and only one episode of a small non-fatal pulmonary embolus in a patient suffering trauma to the amputation stump after discharge from the hospital. This study suggests that clinically significant venous thromboembolism following current techniques of lower extremity amputation is not as common as previously reported. Doppler ultrasound is the most suitable technique for surveillance of venous thrombosis in these patients.

Adult↗
PubMedDate not supplied

Hallux amputation for diabetic osteomyelitis.

Digital amputation for infection in the diabetic patient requires accurate assessment of wound healing potential as a function of clinical and noninvasive studies of cutaneous blood flow. The diabetic propensity for staphylococcal infection, microangiopathy, and delayed wound healing may be questionable in light of recent literature. X-rays, xeroradiographs, and bone scans are useful guides to osseous infection involvement. Amputation technical planning is mandatory. Proper assessment results in a dynamic functional amputation stump with little impact on gait.

Adult↗
PubMed1978

Long-term effects of partial limb amputation in man.

Ten patients with amputation of part of one arm have been studied electrophysiologically. In each patient the ulnar nerve was stimulated electrically in the amputation stump and at a corresponding level in the intact limb. Control observations were also made on 15 normal subject. In the partially-amputated (PA) limbs the amplitudes of the centripetal ulnar nerve compound action potentials, after maximal stimulation of fast-conducting fibres, were markedly reduced in comparison with the results in control limbs. A small decrease in the mean impulse conduction velocity was observed in the population of PA limbs. In comparison with control observations, stimulation of the ulnar nerve in a PA limb evoked responses in the contralateral somatosensory cortex which were significantly diminished. Simulation of PA limbs caused reflex excitation and inhibition of triceps motoneurones similar to that observed in control subjects. In the intact limbs of the amputees, however, inhibition was reduced, possibly as a consequence of overuse. It is concluded that the receipt of an input from the periphery is essential for the functional integrity of most motor and sensory nerve axons, and probably for fibres in the dorsal column-medial lemniscus pathway.

Action Potentials↗
PubMed1976

The upper-extremity amputee. Early and immediate post-surgical prosthetic fitting.

The results of immediate and early post-surgical prosthetic fitting in eighty-seven upper-extremity amputees as well as the results in nine patients with shoulder dislocation who were fitted with temporary devices were reviewed. No local wound complications occurred and the rate of prosthetic acceptance was high. A practice prosthesis, with a filler insert formed from liquid Silastic foam allowed to set between the walls of the practice prosthesis and the amputation stump, was used extensively in this series. With the Silastic insert and practice prosthesis, prosthetic training could be instituted during healing of the amputation wounds, proximal wounds, or fractures.

Amputation, Surgical↗
PubMed2002

Neurovascular calcaneo-cutaneus pedicle graft for stump capping in congenital pseudarthrosis of the tibia: preliminary report of a new technique.

The operative treatment of congenital pseudarthrosis of the tibia, especially when associated with neurofibromatosis type I (Recklinghausen's disease), often leads to failure. Frequently, regardless of the type of deformity, multiple operative procedures end in the amputation of the affected limb. Soft tissue coverage of the amputation stump may confront the surgeon with new problems. Secondary perforation of the soft tissue envelope of the stump owing to terminal overgrowth is not a rare complication. A new technique of stump capping is demonstrated in a 10-year-old boy and a 14-year old girl, both with congenital pseudarthrosis of the tibia of the right leg and neurofibromatosis. During this procedure, a radical resection of the pseudarthrotic tissue is performed although all neurovascular structures supplying the calcaneus are carefully maintained (Arteria, vena et nervus tibialis posterior et peronealis). Subsequently, the tibia and fibula are inserted into the calcaneus. This construct is stabilized with two crossed Kirschner wires. Afterwards, the skin of the lower limb and the hindfoot are sutured together covering the neurovascular bundles, which are arranged in a loop-like fashion. The documented active range of motion was similar to that of the unaffected knee joint. Twelve weeks after operation in both patients, full weight bearing was achieved with a lower-leg prosthesis. This new procedure leads to a durable, full weight-bearing stump with complete sensitive innervation without the risk of future soft tissue perforation caused by the growing bone. The stump fits with an end-bearing lower-leg prosthesis.

Adolescent↗
PubMed1991

Perturbation of the motor system in freely walking cockroaches. II. The timing of motor activity in leg muscles after amputation of a middle leg.

1. The effects of amputation of a middle leg on the motor pattern in the legs of freely walking cockroaches (Periplaneta americana L.) were studied. 2. The general effects of amputating a middle leg are similar to those arising from amputation of a rear leg. These effects are: multiple bursting, more variable and inconsistent timing (phase) between bursts and a tendency for timing effects to appear only during relatively slow walking. 3. The phase of bursts in the amputated stump relative to bursts in the leg in front of it was speed-dependent. However, the phase of stump bursts relative to bursts in the legs across from and behind the stump were not especially dependent on the speed of walking. In general, the phases of bursts in most leg pairs seemed relatively little affected by the amputation except for an increase in scatter. 4. It is concluded that loss of a middle leg disrupts the motor pattern less severely than does loss of a rear leg. The implications of this and other results for the understanding of motor control are discussed.

Amputation, Surgical↗
PubMed1995

[The value of technetium scintigraphy for early diagnosis and therapy of severe frostbite].

Frostbites often present with a discrepancy between skin lesions and damage to deeper structures. 14 patients with the diagnosis of severe frostbite and/or hypothermia had been treated between 1990 and 1993. In addition to our standard approach including history, physical exam, and Doppler/Laser-Doppler studies, we performed technecium 99 scintigraphies in seven patients at three to five days after injury. In six patients (86%), there was an excellent correlation between scintigraphic and intraoperative findings. We conclude that early diagnosis and treatment of avital tissue reduces length of hospital stay and allows for maximum amputation stump length preservation.

Adolescent↗
PubMed1986

[Value of Samii's method in the treatment of digital neuromas].

The treatment of pain after digital amputation consists of surgical treatment if the pain is due to excessive nociception on the nerve. With micro-surgical technique, it is possible, like Samii, to suture some of the fascicles into central direction with the other nerves fascicles, after resection of the nervroma; or to anastomose the nerve with the other nerve, if we have two nevromas on the same digital amputation stump. Results of this technique are generally progressive disappearance of the pain.

Adult↗